How to protect the children of the frontline

Attending the annual conference of the Centre for Blast Injuries Studies (CBIS) last week I was struck by the depth of research and resource that has gone into protecting soldiers from blast injury.

According to Dr Rebecca Brown of the International Blast Injury Research Network (IBRN) over $1 billion has been spent on blast injury research since 2000, the vast majority by the US military. This money has focused on adult males between the ages of 18-35. It has been spent looking into prevention, protection and treatment largely for soldiers hurt by the ubiquitous ‘improvised explosive devices’ (IEDs) that have played such central roles in conflicts in Iraq and Syria.

Iain Gibb, a member of the Royal Army Medical Corps, showed a slide during his presentation at the CBIS conference of NATO soldiers on patrol surrounded by local Afghan children. He noted that the soldiers were wearing body armour, knee guards, eye protection, specially designed boots and helmets. The children around them were wearing only thin cotton. It should come as no surprise therefore that 53% of civilian harm from explosive violence comes from IEDs killing and maiming those with little protection.

All the panellists on a session looking specifically at the challenge of paediatric blast injury noted that there is a difference between physiology of children and adults. Yet despite 1 in 5 children around the world living in areas affected by conflict the field of paediatric blast injury research is very much a nascent one.

Our recent report “Blast Injuries” highlighted how children are more likely to die following blast injuries than adults and that children are overwhelmingly likely to experience head injuries, with head and burn injuries from blast injuries a significant cause of death in young children.

The Paediatric Blast Injury Partnership (PBIP) is less than two years old and represents the tip of the spear in looking into this issue. The publication of a series of articles in the BMJ and the Lancet has been followed by the release of the world’s first ever Paediatric Blast Injury Field Manual in May.

Designed originally for use by Syrian medics from Syria Relief, the manual has already found itself in the hands of medics in Libya, Afghanistan, Somalia, Nigeria, the Philippines, Lebanon and Ukraine. An Arabic translation is soon to be released and there are plans for getting it to medics in Yemen and Iraq in the near future.

Yet there is so much more to be done. Michael von Bertele, formerly of Save the Children International, is leading the way in the establishment of a Global Paediatric Trauma Register, that for the first time can bring together all the data around children who are injured in war and help inform decisions and research around improved mortality.

Paul Reavley, the lead author of the field manual, is already looking into an updated version and to a set of accompanying tools that can be used to help save children’s lives when they are hurt by bombs.

Discussions at the CBIS conference speculated that if the current trends in modern conflict continue, then we could see the development of armoured school buses and children wearing school uniforms made of Kevlar and other protective fibres. This is a shocking indictment of the continued failure of adults to protect children from the consequences of their wars.

Delivering a keynote speech at the conference, Save the Children’s Kevin Watkins committed the organisation to working on this challenge for the long haul. Thinking into the future is critically needed in this space as children who suffer these types of injuries will live with them for decades.